Survival of a large cohort of HIV-infected tuberculosis patients in the era of highly active antiretroviral treatment

• Published in: The international journal of tuberculosis and lung disease Vol. 15; no. 2; pp. 263 - 269
• Main Authors: CATALA, L, ORCAU, A, GARCIA DE OLALLA, P, MILLET, J.-P, RODRIGUEZ-MONDRAGON, A, CAYLA, J. A
• Format: Journal Article
• Language: English
• Published: Paris, France IUATLD 01.02.2011; International Union against Tuberculosis and Lung Disease
• Subjects: Adult; AIDS; AIDS-Related Opportunistic Infections - drug therapy; AIDS-Related Opportunistic Infections - etiology; AIDS-Related Opportunistic Infections - mortality; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiretroviral Therapy, Highly Active; Antirheumatic Agents - therapeutic use; Antitubercular Agents - therapeutic use; Antiviral agents; Bacterial diseases; Biological and medical sciences; Cause of Death; Causes Of Death; Chi-Square Distribution; Cohort Study; Cox Regression; Female; HIV Infections - complications; HIV Infections - drug therapy; HIV Infections - mortality; Human bacterial diseases; Human immunodeficiency virus; Human viral diseases; Humans; Infectious diseases; Kaplan-Meier Estimate; Male; Medical sciences; Mycobacterium; Pharmacology. Drug treatments; Pneumology; Proportional Hazards Models; Respiratory system : syndromes and miscellaneous diseases; Retrospective Studies; Risk Assessment; Risk Factor; Risk Factors; Spain - epidemiology; Survival Analysis; Survival Rate; Time Factors; Treatment Outcome; Tuberculosis; Tuberculosis - drug therapy; Tuberculosis - etiology; Tuberculosis - mortality; Tuberculosis and atypical mycobacterial infections; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Spain; Immunopathology; Prognosis; causes of death; Respiratory disease; Regression; AIDS; Mycobacterial infection; Immune deficiency; Survival; Infection; Treatment; Tuberculosis; survival analysis; Viral disease; Cohort study; Risk factor; Bacteriosis; Antiviral; Death; Cox regression; Pneumology
• ISSN: 1027-3719; 1815-7920

OBJECTIVES: To determine the survival rate, predictive factors and causes of death in a cohort of human immunodeficiency virus (HIV) infected tuberculosis (TB) patients in the era of highly active antiretroviral treatment (HAART).DESIGN: This retrospective cohort study included all HIV-infected TB patients reported in Barcelona between 1996 and 2006. A survival analysis was conducted based on the Kaplan-Meier estimator and Cox proportional hazards; hazard ratios (HRs) and their 95% confidence intervals (CIs) were calculated. Causes of death were classified using the International Classification of Diseases (ICD) 9 and ICD-10, and defined as acquired immune-deficiency syndrome (AIDS) related, non-AIDS-related or unknown.RESULTS: Of the 792 patients included, 341 (43.1%) died. Survival at 10 years was 47.4% (95%CI 45.2-49.6). Poorer survival was observed in patients aged >30 years (HR 1.6, 95%CI 1.1-2.1), inner-city residents (HR 1.3, 95%CI 1.1-1.7), injecting drug users (HR 1.4, 95%CI 1.1-1.8), those with a non-cavitary radiological pattern (HR 1.5, 95%CI 1.0-2.2), those with <200 CD4/μl (HR 1.8, 95%CI 1.2-2.7) and those diagnosed with AIDS prior to their TB episode (HR 1.85, 95%CI 1.4-2.2). No differences were found for TB treatment (6 vs. 9 months) or for anti-tuberculosis drug resistance; 64.8% of the deaths were non-AIDS-related.CONCLUSIONS: Poor survival was observed despite the availability of HAART, and non-AIDS-related mortality was high. Earlier HAART could help address AIDS and non-AIDS-related mortality.